Retail clinics don't reduce ER use for low-acuity conditions

Some researchers and policymakers had hoped the surge of retail clinics across the country would reduce visits to the emergency department. A new study finds that hasn't been the case.

The report, published Monday in the Annals of Emergency Medicine, found ERs in close proximity to retail clinics didn't experience a reduction of visits from patients with low-acuity illnesses like influenza, urinary tract infections and ear aches.

The study, conducted by researchers at Rand Corp., was the first to explore the association between the opening of retail clinics and admissions to the ER.

About 13.7% of all emergency department visits are for low-acuity conditions, the study notes.

Some healthcare experts have argued that retail clinics could potentially reduce ER visits because they can help patients with low-acuity ailments. Retail clinics are typically staffed by nurse practitioners, don't require an appointment and wait times are usually short. The clinics also accept most types of private insurance and Medicare, the authors write.

The number of clinics has risen significantly in recent years. About 130 retail clinics existed in 2006. Now more than 2,000 clinics have been established, the researchers note. The clinics are usually located within retail giants like Wal-Mart.

The authors examined low-acuity admission rates at 2,043 ERs from 2006 to 2012 using data from the Healthcare Cost and Utilization Project State Emergency Database. Changes in admission rates were studied over the six-year period for ERs located within a 10-minute drive of a retail clinic. Retail clinics were identified by Merchant Medicine, a research firm that tracks clinics.

The study found no correlation between the opening of a retail clinic and a reduction in ER visits for low-acuity conditions.

The researchers note that patients may still go to the ER for low-acuity ailments because they had “concerning symptoms” or suffer from other chronic conditions that prompt them to seek immediate care.

At the same time, only 60% of retail clinics accept Medicaid but the Medicaid population uses the ER the most for low-acuity ailments. By comparison, 97% of retail clinics accept private insurance and 93% accept Medicare.

Retail clinics are more likely to be located in affluent areas with a high percentage of privately insured or Medicare beneficiaries because they want to be reimbursed for their services, said Grant Martsolf, lead author of the study and a policy researcher at Rand Corp.

And unlike ERs, clinics aren't required to treat the uninsured, he added.

The study did find a slight decline in ER use among privately insured populations but “the effect sizes were very small,” the authors note.

Perhaps surprisingly, retail clinics may even be motivating patients to seek care when they normally wouldn't, Martsolf said.

Usually people with temporary conditions like an ear infection wouldn't seek care from their primary care provider or the ER. The convenience of a local clinic may be encouraging people to seek out healthcare services more, Martsolf said.

“Historically, if the clinic wasn't there they wouldn't have gone at all,” Martsolf said. “Its created this new utilization.”